Women’s Health USA 2011 October 2011 U.S. Department of Health and Human Services Health Resources and Services Administration Please note that Women’s Health USA 2011 is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication; however, the photographs are copyrighted and permission may be required to reproduce them. Suggested Citation: U.S. Department of Health and Human Services, Health Resources and Services Administration. Women’s Health USA 2011. Rockville, Maryland: U.S. Department of Health and Human Services, 2011.  is publication is available online at http://mchb.hrsa.gov/ and http://hrsa.gov/womenshealth/ Single copies of this publication are also available at no charge from the HRSA Information Center P.O. Box 2910 Merri eld, VA 22116 1-888-ASK-HRSA or ask@hrsa.gov WOMEN’S HEALTH USA 2011 CONTENTS 3 PREFACE AND READER’S GUIDE 4 INTRODUCTION 6 POPULATION CHARACTERISTICS 9 U.S. Population 10 U.S. Female Population 11 Rural and Urban Women 12 Household Composition 13 Women and Poverty 14 Food Security 15 Women and Federal Nutrition Programs 16 Educational Attainment 17 Women in the Labor Force 18 Women Veterans 19 HEALTH STATUS 20 Health Behaviors Physical Activity 21 Nutrition 22 Alcohol Use 23 Cigarette Smoking 24 Illicit Drug Use 25 Health Indicators Life Expectancy 26 Leading Causes of Death 27 Health-Related Quality of Life 28 Activity Limitations 29 Overweight and Obesity 30 Diabetes 31 High Blood Pressure 32 Heart Disease and Stroke 33 Cancer 34 Secondhand Tobacco Smoke Exposure 36 Asthma 37 Mental Illness 38 Violence Against Women 39 Sexually Transmitted Infections 40 HIV/AIDS 41 Arthritis 42 Osteoporosis 43 Alzheimer’s Disease 44 Sleep Disorders 45 Oral Health 46 Reproductive and Maternal Health Preconception Health 47 Unintended Pregnancy and Contraception 48 Smoking During Pregnancy 49 Live Births and Delivery Type 50 Maternal Morbidity and Mortality 51 Postpartum Depressive Symptoms 52 Breastfeeding 53 Maternity Leave 54 Special Populations Lesbian and Bisexual Women 55 American Indian and Alaska Native Women 56 Native Hawaiian and Other Pacifi c Islander Women 57 HEALTH SERVICES UTILIZATION 58 Health Insurance 59 Medicaid and Medicare 60 Barriers to Care and Unmet Need for Care 61 Usual Source of Care 62 Preventive Care 63 Vaccination 64 HIV Testing 65 Mental Health Care Utilization 66 Oral Health Care Utilization 67 Hospitalization and Home Health Care 68 Organ Transplantation 69 Health Care Expenditures 70 Quality of Women’s Health Care 71 HEALTHY PEOPLE 2020 72 HRSA PROGRAMS RELATED TO WOMEN’S HEALTH 73 ENDNOTES 74 DATA SOURCES 78 CONTRIBUTORS AND INDICATORS IN PREVIOUS EDITIONS 80 WOMEN’S HEALTH USA 20114 PREFACE AND READER’S GUIDE  e U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) supports healthy women building healthy communities. HRSA is charged with ensuring access to quality health care through a network of community- based health centers, maternal and child health programs, and community HIV/AIDS programs throughout the States and U.S. jurisdictions. In addition, HRSA’s mission includes supporting individuals pursuing careers in medicine, nursing, and many other health disciplines. HRSA ful lls these responsibilities, in part, by collecting and analyzing timely, topical information that identi es health priorities and trends that can be addressed through program interventions and capacity building. HRSA is pleased to present Women’s Health USA 2011, the tenth edition of the Women’s Health USA data book. To re ect the ever- changing, increasingly diverse population and its characteristics, Women’s Health USA selectively highlights emerging issues and trends in women’s health. Data and information on second-hand tobacco smoke exposure, preconception health, oral health care, and barriers to health care are a few of the new topics included in this edition. In addition, new special population features present data on the WOMEN’S HEALTH USA 2010 PREFACE 5 health of lesbian and bisexual women, as well as the indigenous populations of American Indian and Alaska Native women and Native Hawaiian and other Paci c Islander women. Disparities by sex, race and ethnicity, and socioeconomic factors, including education and income, are highlighted throughout the document where possible. Where race and ethnicity data are reported, groups are mutually exclusive (i.e., non-Hispanic race groups and the Hispanic ethnic group) except in a few cases where the original data are not presented separately.  roughout the data book, those categorized as being of Hispanic ethnicity may be of any race or combination of races. In some instances, it was not possible to provide data for all races due to the design of the original data source or the size of the sample population; therefore, estimates with a relative standard error of 30 percent or greater were considered unreliable and were not reported.  e data book was developed by HRSA to provide readers with an easy-to-use collection of current and historical data on some of the most pressing health challenges facing women, their families, and their communities. Women’s Health USA 2011 is intended to be a concise reference for policymakers and program managers at the Federal, State, and local levels to identify and clarify issues a ecting the health of women. In these pages, readers will  nd a pro le of women’s health from a variety of data sources.  e data book brings together the latest available information from various agencies within the Federal government, including the U.S. Department of Health and Human Services, U.S. Department of Agriculture, U.S. Department of Labor, and U.S. Department of Justice. Non-Federal data sources were used when no Federal source was available. Every attempt has been made to use data collected in the past 5 years. It is important to note that the data included are generally not age- adjusted to the 2000 population standard of the United States.  is a ects the comparability of data from year to year, and the interpretation of di erences across various groups, especially those of di erent races and ethnicities. Without age adjustment, it is di cult to know how much of the di erence in incidence rates between groups can be attributed to di erences in the groups’ age distributions. Women’s Health USA 2011 is avail- able online through the HRSA Mater- nal and Child Health Bureau (MCHB), O ce of Women’s Health Web site at www.hrsa.gov/WomensHealth or the MCHB O ce of Epidemiology, Policy and Evaluation Web site at www.mchb.hrsa.gov/researchdata. Some of the topics covered in Women’s Health USA 2010 were not included in this year’s edi- tion either because new data were not available or because preference was given to an emerging issue in women’s health. For coverage of these issues, please refer to Women’s Health USA 2010, also available online.  e National Women’s Health Information Center, located online at www.womenshealth.gov, has detailed women’s and minority health data and maps.  ese data are available through Quick Health Data Online at www.healthstatus2010.com/owh. Data are available at the State and county levels, by age, race and ethnicity, and sex.  e text and graphs in Women’s Health USA 2011 are not copyrighted; the photographs are the property of istockphoto.com and may not be duplicated. With that exception, readers are free to duplicate and use any of the information contained in this publication. Please provide any feedback on this publication to the HRSA Information Center which o ers single copies of the data book at no charge: HRSA Information Center P.O. Box 2910 Merri eld, VA 22116 Phone: 703-442-9051 Toll-free: 1-888-ASK-HRSA TTY: 1-877-4TY-HRSA Fax: 703-821-2098 Email: ask@hrsa.gov Online: www.ask.hrsa.gov WOMEN’S HEALTH USA 20116 INTRODUCTION In 2009, females represented 50.7 percent of the 307 million people residing in the United States. In most age groups, women accounted for approximately half of the population, with the exception of people aged 65 years and older; within this age group, women represented 57.5 percent of the population.  e growing diver- sity of the U.S. population is re ected in the racial and ethnic distribution of women across age groups. Non-Hispanic Black and Hispanic women accounted for 8.9 and 6.9 percent of the female population aged 65 years and older, but they represented 13.8 and 22.4 percent of fe- males under 18 years of age, respectively. Non- Hispanic Whites accounted for 79.7 percent of women aged 65 years and older, but only 55.0 percent of those under 18 years of age. Hispanic women now account for a greater proportion of the female population than they did in 2000, when they made up 17.0 percent of the popula- tion under age 18 and only 4.9 percent of those 65 years and older. America’s growing diversity underscores the importance of examining and addressing ra- cial and ethnic disparities in health status and the use of health care services. In 2007–2009, 58.1 percent of non-Hispanic White women reported themselves to be in excellent or very good health, compared to only 40 percent or less of Hispanic, non-Hispanic American In- dian/Alaska Native, and non-Hispanic Black women. Minority women are disproportionate- ly a ected by a number of diseases and health conditions, including HIV/AIDS, sexually transmitted infections, diabetes, and asthma. For instance, in 2009, rates of new HIV cases were highest among non-Hispanic Black, non- Hispanic multiple race, Non-Hispanic Native Hawaiian/Paci c Islander, and Hispanic fe- males (47.8, 13.4. 13.3, and 11.9 per 100,000 females, respectively), compared to just 2.4 cases per 100,000 non-Hispanic White females. Hypertension, or high blood pressure, was WOMEN’S HEALTH USA 2011 INTRODUCTION 7 also more prevalent among non-Hispanic Black women than women of other races. In 2005– 2008, 39.4 percent of non-Hispanic Black women were found to have high blood pressure, compared to 31.3 percent of non-Hispanic White, 16.3 percent of Mexican American, and 19.9 percent of other Hispanic women. Diabetes is a chronic condition and a leading cause of death and disability in the United States, and is especially prevalent among minority and older adults. In 2007–2009, 14.0 percent of non-Hispanic American Indian/Alaska Native women and 11.9 percent of non-Hispanic Native Hawaiian/Other Paci c Islander women reported having been diagnosed with diabetes compared to 6.4 percent of non-Hispanic White women. Hispanic and non-Hispanic Black women also have higher rates of diabetes. As indigenous populations that share similar histories of disenfranchisement, American Indi- an/Alaska Natives and Native Hawaiian/Other Paci c Islanders have some health disparities in common related to substance abuse and chronic conditions, like diabetes. However, American Indian/Alaska Native women have especially high rates of injury, while Native Hawaiian/ Other Paci c Islanders have higher cancer inci- dence and mortality. In addition to race and ethnicity, income and education are important factors that contribute to women’s health and access to health care. Re- gardless of family structure, women are more likely than men to live in poverty. In 2009, poverty rates were highest among women who were heads of their households with no spouse present (27.1 percent). Poverty rates were also high among non-Hispanic American Indian/ Alaska Native, non-Hispanic Black, and His- panic women (25.5, 24.3, and 23.8 percent, respectively). Women in these racial and eth- nic groups were also more likely to be heads of households than their non-Hispanic White, non-Hispanic Asian, and non-Hispanic Native Hawaiian/Paci c Islander counterparts. Many conditions and health risks are more closely linked to education and family income than to race and ethnicity and di erences in poverty tend to explain a large portion of ra- cial and ethnic health di erences. For example, healthy choices for diet and exercise may not be as accessible to those with lower incomes and may contribute to higher obesity levels among minority women. In 2005–2008, 40.0 percent of women with household incomes less than 100 percent of poverty were obese, compared to 31.1 percent of women with incomes of 300 percent or more of poverty. Sleep disorders, such as insomnia and sleep apnea, were also more common among women with lower household incomes. In 2005–2008, 10.5 percent of women with household in- comes below 100 percent of poverty had been diagnosed with a sleep disorder, compared to 5.5 percent of women with incomes of 300 percent or more of poverty. Oral health status and receipt of oral health care among women also varied dramatically with household in- come. In 2005–2008, women with household incomes below poverty were 3 times more likely to have untreated dental decay than women liv- ing in households with incomes of 300 percent or more of poverty (30.3 versus 10.3 percent, respectively). Less than half of women with incomes below 100 percent of poverty had re- ceived a dental visit in the past year (43.2 per- cent), compared to 77.7 percent of women with household incomes of 400 percent or more of poverty. In addition to race and ethnicity and income, disparities in health status and behaviors, as well as health care access, are also observed by sexual orientation. In 2006–2008, only 37.4 percent of lesbian women received a Pap smear in the past year compared to over 60 percent of heterosexual and bisexual women. Bisexual women were also less likely than heterosexual women to have health insurance or report excellent or very good health status. Both lesbian and bisexual women reported high rates of smoking and binge drinking. WOMEN’S HEALTH USA 2011INTRODUCTION8 Although women can expect to live 5 years longer than men on average, women experience more physically and mentally unhealthy days than men. In 2007–2009, women reported an average of 4.0 days per month that their physi- cal health was not good and 3.9 days per month that their mental health was not good, com- pared to an average of 3.2 physically unhealthy and 2.9 mentally unhealthy days per month reported among men. Due to their longer life expectancy, women are more likely than men to have certain age-related conditions like Al- zheimer’s disease. Regardless of age, however, women are more likely to have asthma, arthri- tis, osteoporosis, and activity limitations. For example, 9.2 percent of women had asthma in 2007–2009, compared to 5.5 percent of men. Men, nonetheless, bear a disproportion- ate burden of other health conditions, such as HIV/AIDS, high blood pressure, and coronary heart disease. In 2008, for instance, the rate of newly reported HIV cases among adolescent and adult males was more than 3 times the rate among females (32.7 versus 9.8 per 100,000, re- spectively). Despite the greater risk, however, a smaller proportion of men had ever been tested for HIV than women (36.1 versus 41.0 percent, respectively). In addition, men were more likely than women to lack health insurance and less likely to have received a preventive check-up in the past year. Many diseases and health conditions, includ- ing some of those mentioned above, can be avoided or minimized through good nutrition, regular physical activity, and preventive health care. In 2009, 65.8 percent of women aged 65 years and older reported receiving a  u vaccine; however, this percentage ranged from about 50 percent of non-Hispanic Black and Hispanic women to 69.0 percent of non-Hispanic White women. Regular physical activity and a healthy diet have numerous health bene ts, such as helping to prevent obesity and chronic conditions like diabetes, heart disease, and certain types of can- cer. In 2007–2009, only 14.7 percent of women participated in at least 2.5 hours of moderate intensity physical activity per week or 1.25 hours of vigorous intensity activity per week in addition to muscle-strengthening activities on 2 or more days per week.  e majority of women (83.1 percent) also exceeded the recommended daily maximum intake of sodium—a contribu- tor to high blood pressure, cardiovascular, and kidney disease. Not smoking or quitting smoking is another important component to disease prevention and health promotion. Smoking during pregnancy is particularly harmful for both mother and in- fant. Women with lower incomes and less edu- cation are more likely to smoke and less likely to quit, both overall and during pregnancy. Past month smoking rates are also highest among non-Hispanic American Indian/Alaska Native women (41.8 percent) and lowest among non- Hispanic Asian women (8.3 percent). Women’s Health USA 2011 is an important tool for emphasizing the importance of preven- tive care, counseling, and education, and for illustrating disparities in the health status of women from all age groups and racial and eth- nic backgrounds. Health problems can only be remedied if they are recognized.  is data book provides information on a range of indicators that can help us track the health behaviors, risk factors, and health care utilization practices of women and men throughout the United States. WOMEN’S HEALTH USA 2011 9 POPULATION CHARACTERISTICS Population characteristics describe the diverse social, demographic, and economic features of the Nation’s population.  ere were more than 155 million females in the United States in 2009, representing slightly more than half of the population. Examining data by demographic factors such as sex, age, and race and ethnicity can serve a number of purposes for policymakers and program planners. For instance, these comparisons can be used to tailor the development and evaluation of policies and programs to better serve the needs of women at higher risk for certain conditions.  is section presents data on population characteristics that may a ect women’s physical, social, and mental health, as well as access to health care. Some of these characteristics include age, race and ethnicity, rural or urban residence, education, poverty, employment, household composition, and participation in Federal nutrition programs.  e characteristics of women veterans are also reviewed and analyzed. U.S. Population, by Age and Sex, 2009 Source I.1: U.S. Census Bureau, American Community Survey Number in Thousands 21,067 20,306 20,970 31,659 30,191 151,375 155,631 22,234 20,880 21,983 22,614 20,795 16,771 16,781 22,725 18,030 Female Male 65 Years and Older 55-64 Years45-54 Years35-44 Years25-34 Years15-24 YearsUnder 15 YearsTotal 5,000 10,000 15,000 20,000 25,000 30,000 35,000 140,000 150,000 160,000 WOMEN’S HEALTH USA 2011POPULATION CHARACTERISTICS10 U.S. POPULATION In 2009, the U.S. population was more than 307 million, with females comprising 50.7 percent of that total. Females younger than 35 years of age accounted for 45.9 percent of the female population, those aged 35–64 years ac- counted for 39.5 percent, and females aged 65 years and older accounted for 14.6 percent.  e distribution of the population by sex was fairly even across younger age groups; however, due to their longer life expectancy, women accounted for a greater percentage of the older population than men. Of those aged 65 and older, 57.5 percent were women. U.S. Female Population, by Age, 2009 Source I.1: U.S. Census Bureau, American Community Survey 45-54 Years 14.5% 65 Years and Older 14.6% Under 15 Years 19.4% 15-24 Years 13.5% 25-34 Years 13.0% 55-64 Years 11.6% 35-44 Years 13.4% [...]... Adults Aged 18 and Older, by Level of Drinking* and Sex, 2007–2009 Binge and Heavy Alcohol Consumption* in the Past Month Among Women Aged 18 and Older, by Race/Ethnicity, 2007–2009 Source II.3: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health Source II.3: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health 62.3... Among Adults Aged 18 and Older, by Poverty Status* and Sex, 2007–2009 Recent Smoking Cessation* Among Adults Aged 18 and Older, by Poverty Status** and Sex, 2007–2009 Source II.3: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health Source II.3: Substance Abuse and Mental Health Services Administration, National Survey o Drug Use and Health Female Male 50... education and live farther from health care resources than their urban counterparts Rural areas also have fewer physicians and dentists per capita than urban areas, and may lack certain specialists altogether.3 Geographic isolation and limited access to health care can result in delayed diagnosis and treatment of health conditions Rural/urban residence varies by race and WOMEN’S HEALTH USA 2011 Educational... symptoms, and maternity leave In addition, special pages are devoted to summarizing the health of lesbian and bisexual women, as well as the indigenous populations of American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander women The data throughout this section are displayed by various characteristics including sex, age, race and ethnicity, education, and income WOMEN’S HEALTH USA 2011 WOMEN’S. .. current health interventions and the need for new programs Studying trends in health status can help to identify new issues as they emerge In this section, health status indicators related to morbidity, mortality, health behaviors, and maternal health are presented New topics include health- related quality of life, secondhand tobacco smoke exposure, Alzheimer’s disease and dementia, preconception health, ... physical and mental health, non-Hispanic American Indian/Alaska Native and non-Hispanic women of multiple races reported the highest average number of unhealthy days in the past month (6.5 and 5.9 physically unhealthy days, respectively; 5.8 mentally unhealthy days for both groups) Non-Hispanic Asian women reported the lowest number of physically and mentally unhealthy days on average (2.5 and 2.4 unhealthy... 22 HEALTH STATUS – HEALTH BEHAVIORS WOMEN’S HEALTH USA 2011 NUTRITION The 2010 Dietary Guidelines for Americans recommends eating a variety of nutrient-dense foods while not exceeding caloric needs For most people, this means eating a daily assortment of fruits and vegetables, whole grains, lean meats, seafood and beans, and reduced fat milk products while limiting added sugar, sodium, saturated and. .. some point in their lives and smoked in the past 3 years; excludes adults who started smoking in the past year **Poverty level, defined by the U.S Census Bureau, was $21,954 for a family of four in 2009 WOMEN’S HEALTH USA 2011 HEALTH STATUS – HEALTH BEHAVIORS ILLICIT DRUG USE Illicit drug use is associated with serious health and social consequences, including addiction and drug-induced death, impaired... Health Services Administration, National Survey on Drug Use and Health 25 Other Pacific Islander and non-Hispanic women of multiple races (17.5, 17.6, and 17.7 percent, respectively) and lowest among non-Hispanic Asian women (5.4 percent) Racial and ethnic differences for specific types of illicit drugs are generally similar to differences for any illicit drug use However, non-Hispanic White and Hispanic... for Black females Between 1970 and 2008, the greater WOMEN’S HEALTH USA 2011 gains in life expectancy for males than females and for Blacks than Whites have led to reduced disparities by sex and race While life expectancy estimates have not historically been calculated and reported for the Hispanic, Asian, Native Hawaiian/Pacific Islander, American Indian/Alaska Native, and multiple race populations, . Women’s Health USA 2011 October 2011 U.S. Department of Health and Human Services Health Resources and Services Administration Please note that Women’s. U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) supports healthy women building healthy communities.